ADOLESCENCE REPRODUCTIVE

HEALTH
Dicky Moch Rizal
Dept. of Physiology, Fac. Of Medicine, Universitas
Gadjah Mada
drdickyandrologi@ugm.ac.id
LEARNING OBJECTIVE
 Definition of adolescent
 Process of puberty

 Abnormality of reproductive organ during

puberty
 Adolescence reproductive health issues

 Adolescence reproductive health problems and

life style changes
 Definition of adolescence
 Adolescence (Latin:adolescere meaning "to grow
up")
 is a transitional stage of physical and mental human
development generally occurring
between puberty and legal adulthood (age of
majority),but largely characterized as beginning and
ending with the teenage stage
CLASSIFICATION OF PUBERTY

 Early adolescence corresponds to : 10-15 yo

(when most youth are entering high school)
 Middle adolescence : typically 14 -18 yo

 Late adolescence refers to 17-18 yo into the early

twenties (the years past high school)

 Historically, puberty has been heavily associated

with teenagers and the onset of adolescent
development
 An individual is considered to be (chronologically and
legally) mature enough to be entrusted by society
with certain tasks
WHAT THE CHANGES?
 Emotionally,
 a sense of identity during late adolescence;
 social involvement,
 peer interaction,
 sexual interest,

 Driving a vehicle, having legal sexual relations,

serving in the armed forces or on a jury, purchasing
and drinking alcohol, voting, entering into contracts,
completing certain levels of education, and marrying.

 LEGACY of LAW
JAMES MARCIA STATEMENT ( IDENTITY
STATUS THEORY)

 Identity diffused or identity confused.

Individuals who had not yet experienced an
identity crisis

 Foreclosure. Individuals who have not

experienced crisis, but has made commitments,
however, these commitments are not the result of
his own searching and exploring, but they are
handed to him, ready-made, by others, frequently
his parents
 Moratorium. Individuals who are in an acute
state of crisis.
 They are exploring and actively searching for
alternatives, and struggling to find their identity; but
have not yet made any commitment or have only
developed very temporary kinds of commitment

 Identity Achieved. Individuals who have

experienced crises but have resolved them on
their own terms, and as a result of the resolution
of the crisis had made a personal commitment to
an occupation, a religious belief, a personal value
system; and, has resolved their attitude toward
sexuality
PUBERTY
HTTPS://M.GLOWM.COM/RESOURCES/GLOWM/CD/PAGES/V5/V5C009.HTML

 Simplified scheme of the endocrine interactions that regulate pubertal development. GnRH, gonadotropin-releasing hormone; GH,
growth hormone; IGF-I, insulin-like growth factor I; IGF-BP1, IGF binding protein 1; SHBG, sex hormone–binding globulin.(Nobels
F, Dewailly DD: Puberty and polycystic ovarian syndrome: The insulin/insulin-like growth factor I hypothesis. Fertil Steril 58:655,
1992.)
THE VENTRAL PREMAMMILLARY NUCLEUS (PMV) EXPRESSES A DENSE COLLECTION OF
LEPTIN LONG FORM (LEPRB) AND SEX STEROID RECEPTORS (ER/ESTROGEN RECEPTOR
AND AR/ANDROGEN RECEPTOR) AND IS RESPONSIVE TO ENVIRONMENTAL CUES (ODOR
AND PROBABLY DAYLIGHT IN SEASONAL BREEDERS).
ANTEROVENTRAL PERIVENTRICULAR NUCLEUS (AVPV), SUPPOSEDLY THOSE
EXPRESSING KISS1).
OTHER FACTORS INFLUENCE ON PUBERTYWHAT IS IN
OUR ENVIRONMENT THAT EFFECTS
PUBERTY?HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC4096833/

 Intrinsic factors unique to individuals

 Naturally occurring endocrine disruptors

 Chemical endocrine disruptors

 Phtalate
 BPA
 Pesticide
INTRINSIC FACTORS UNIQUE TO
INDIVIDUALS

 Body weight
 Proposed physiologic mediators of the link between
obesity and pubertal timing include leptin,
adipocytokines and gut peptides
 Prenatal growth
 a lower birth weight alone does not increase a child’s
chance for earlier puberty but that being longer and
lighter at birth does, suggests that under nutrition
and possible rapid postnatal weight gain may
establish metabolic dysregulation
CONT

 Diet
 Women who reported daily milk intake from 5
to 12 years of age experienced menarche 0.317
years earlier than non-milk drinkers
 higher animal protein intake was also
associated with earlier puberty in both boys
and girls
 fiber intake had no effect
 vitamin D deficiency in girls has been
implicated in shifting the age of menarche
downward by ~10 months compared with
controls
 Maternal considerations
 Two independent studies have found maternal
smoking to be associated with earlier puberty

 Psychosocial features
 Stressful life events impart many health concerns
and the evidence for promoting earlier puberty
appears to be increasing.
 This emphasizes the need for improved psychological
treatment of children who are victims of abuse or
high stress environments
NATURALLY COMPOUND
 Endocrine disrupture compund
 endocrine disrupting chemical (EDC) as “an
exogenous agent that interferes with synthesis,
secretion, transport, metabolism, binding action, or
elimination of natural blood-borne hormones that are
present in the body and are responsible for
homeostasis, reproduction, and developmental
processes”
 EDC are naturally and synthetic. (natural source due
to phytoestrogen)---many studies
 Direct effects of environmental exposures on
hypothalamic, pituitary or gonadal hormones
 The DNA changes can be environmentally induced
and inherited by multiple generations independent of
subsequent individual exposures
CHEMICAL ENDOCRINE DISRUPTORS
 first and second generation offspring exhibited
marked alterations in pubertal timing depending
on the gender and the specific exposure involved.

 Most intriguing was the finding that the third

generation females also experienced earlier
puberty after exposure to BPA/phthalate
mixture, dioxin and jet fuel
WHAT HAPPEN WITH EARLY PUBERTY?

 Early-maturing girls are at increased risk of a

range of psychosocial problems including
 depression
 other mental disorder :
 increased anxiety
 negative self-image

 interpersonal stress

 substance use
 early sexual behavior
 taking risky sexual relation/behavior
 abortion/unwanted preganancy
BIOSYNTHESIS OF ANDROGEN
What’s the differences?
http://5mcc.lww.impelsys.com/5mcc/ub/view/5-Minute-Clinical-
Consult/117436/0/Precocious_Puberty__algorithm_
HIRSUTISM…..
 Adolescence is characterized by a number
of cognitive, emotional, physical and attit
udinal changes, which can be a cause of
conflict on one hand and
positive personality development on the
other.
 A huge proportion of the world's
population - more than 1.75 billion - is
young, aged between 10 and 24 years.
http://www.who.int/features/factfiles/adolescent_health/en/i
ndex.html
 Adolescents who have a good relationship with
their parents are less likely to engage in various
risk behaviors, such as smoking, drinking,
fighting, and/or unprotected sexual intercourse
http://www.childtrends.org/Files/FamilyEnvironmentRB.pd
f
 Adolescents are frequently confused about what
is 'right' and what is 'wrong
A combination of behavioural
and fMRI studies have demonstrated
development of executive functions, that
is, cognitive skills that enable the control
and coordination of thoughts and
behaviour, which are generally associated
with the prefrontal cortex. The thoughts,
ideas and concepts developed at this
period of life greatly influence one's future
life, playing a major role in character and
personality formation Choudhury, S.; Blakemore, S.-J.;
Charman, T. (2006). "Social cognitive development during
adolescence". Social Cognitive and Affective Neuroscience 1: 165.
 In
females, oestrogenization related the
susceptibility of the vulva and anterior
vagina to most infections and alters
vaginal flora and pH

 Untilseveral years after menarche, the

squamocolumnar junction is located on
the exposed vaginal surface of the cervix,
gradually progressing to the endocervical
canal as thin columnar cells are
transformed to layers of thick squamous
cells
 The exposed columnar epithelium is
especially likely to become infected with
gonorrhoea or chlamydia if there is
contact with infected partners.
 The transition zone itself is susceptible to
carcinogenic factors, including various
infectious organisms
 Epidemiological evidence that early age of
first intercourse correlates with
precancerous and cancerous changes to
the cervix.
 Within the framework of WHO's definition of
health as a state of complete physical, mental
and social well-being, and not merely the absence
of disease or infirmity, reproductive health
addresses the reproductive processes, functions
and system at all stages of life
 Reproductive health, therefore, implies that
people are able to have a responsible, satisfying
and safe sex life and that they have the
capability to reproduce and the freedom to decide
if, when and how often to do so.
http://www.who.int/topics/reproductive_health/en
/
 It also includes sexual health, the purpose of
which is the enhancement of life and personal
relations, and not merely counseling and care
related to reproduction and sexually transmitted
infections.
 Adolescence Reproductive Health
 Unwanted pregnancy
 Sexually transmitted diseases and AIDS/HIV
 Health and function of the male and female
reproductive systems
 Fertility/Infertility
 Sex education
 Adolescent Reproductive Health Issues around
Pregnancy
According to populationaction.org, every year,
almost 80 million unintended/unplanned
pregnancies occur around the world. More than
half end in abortion.
FACT ABOUT ARH IN US
 Abstinence
 `While some methods may lower the chance of
becoming pregnant or contracting an STD, the only
sure way is through abstinence. Teens can make
more responsible choices when they realize this.
 Teen Sex
 Almost half of United States teenagers have had sex
at least once; 13 percent of teens reported having sex
by the age of 15
 Contraception Use
 One-third of teen girls and just under one-third of teen
boys said they do not use contraception consistently.
Many teens do not think they will get pregnant or
contract an STD by skipping contraception occasionally.
 STDs and HIV/AIDS
 In 2006, almost one million young adults contracted an
STD and 25 percent of sexually active teens get an STD
yearly. 13 percent of people who receive an HIV/AIDS
diagnosis are teens.
 Pregnancy
 Over 400,000 teen girls became pregnant in 2006, and
the majority of these teen parents were underage.
 Teen pregnancy accounts for more than $9 billion
per year in costs to U.S. taxpayers for increased
health care and foster care, increased
incarceration rates among children of teen
parents, and lost tax revenue because of lower
educational attainment and income among teen
mothers
 Pregnancy and birth are significant contributors
to high school drop out rates among girls. Only
about 50% of teen mothers receive a high school
diploma by age 22, versus nearly 90% of women
who had not given birth during adolescence
 The children of teenage mothers are more likely
to have lower school achievement and drop out of
high school, have more health problems, be
incarcerated at some time during adolescence,
give birth as a teenager, and face unemployment
as a young adult
http://www.cdc.gov/TeenPregnancy/AboutTeenPr
eg.htm
PERSONAL VALUES ABOUT SEX AND ABSTINENCE, INDIVIDUAL ABILITY
TO REFUSE SEX AND/OR TO USE CONDOMS.

INTENT TO ABSTAIN FROM SEX, OR LIMIT NUMBER OF PARTNERS .

STD IN ADOLECENT
 Target in 2000 : 400
HIV patient/100.000
 HIV prevalence
increased by
approximately 112,000
(or 11%) from 2003 to
2006 (from 994,000 to
1,106,400 total persons)
UNWANTED PREGNANCY AND ABORTION
CAUSING FACTORS FEMALE INFERTILITY

Endometriosis is confirmed in 50%

to 70% of adolescents whose pelvic
pain fails to respond to NSAIDs
and OCs.
DIET RELATED ADOLESCENT REPRODUCTIVE
HEALTH

The problem :
•Infertility
•CVD
•Sexual dysfunction
•Metabolic syndrom
BAD BEHAVIOR RELATED
ADOLESCENT REPRODUCTIVE
HEALTH
ALCOHOL-DRUG-STD